高屈曲假体初次全膝关节置换术早期随访结果的Meta分析

High-flexion implants in primary total knee arthroplasty： a meta-analysis

目的 分析有关高屈曲假体与普通假体初次全膝关节置换术后疗效比较的文献,对术后关节活动度（range of motion,ROM）及膝关节功能评分（HSS、KSS、WOMAC）进行Meta分析.方法 检索Medline（1966年1月至2009年10月）,Embase（1966年1月至2009年10月）,维普资讯（1989年1月至2009年10月）和CNKI（1979年1月至2009年10月）等数据库中关于高屈曲假体与普通假体在初次伞膝关节置换术中应用的疗效比较的前瞻性随机对照研究,纳人符合标准的文献,提取相关数据输入Review Manager 4.2软件进行统计学分析.术后ROM和膝关节功能评分均采取权重均差（weighted mean difference,WMD）进行评价.结果 共6篇文献符合纳入标准,经改良Jadad评分均判定为高质量研究.纳入病例466例,高屈曲假体组和普通假体组术后ROM合并WMD为1.64195%C1（-0.04,3.32）,P=0.06],膝关节HSS评分合并WMD为0.34[95%CI（-1.12,1.79）,P=0.65],膝关节KSS评分合并WMD为-0.67[95%CI（-2.22,0.89）,P=0.40],膝关节WOMAC评分合并WMD为1.66195%C1（-4.03,7.35）,P=0.57].高屈曲假体组与普通假体组的ROM、HSS、KSS、WOMAC的差异无统计学意义.结论 初次全膝关节置换术后高屈曲假体组相比普通假体组ROM无明显改善,膝关节功能评分无明显差异.

Objective To evaluate the clinical effects between high-flexion and conventional im-plants in primary total knee arthroplasty using the method of meta analysis on range of motion （ROM） and knee function scores （HSS, KSS, WOMAC）. Methods A computer-based online search of Pubmed （1966.1-2009.10）, Embase （1966.1-2009.10）, VIP （1989.1-2009.10） and CNKI （1979.1-2009.10） were performed to collect RCTs and comparison observational studies of comparing high-flexion and conventional knee im-plants. The papers met the criteria were collected, and then extracted the data of ROM and functional out-comes, which were evaluated by Review Manager 4.2 for meta analysis. The weighted mean difference （WMD） method was used with 95%CI. Results A total of 6 studies （466 patients） met our inclusion criteria and all of them were high quality studies. The combined WMD of postoperative ROM between high-flexion and conventional implants was 1.64 [95%CI （-0.04, 3.32）, P=0.06], the combined WMD of HSS scores was 0.34[95%CI（-1.12, 1.79）, P=0.651, the combined WMD of KSS scores was -0.67[95%C/（-2.22, 0.89）, P= 0.40], and the combined WMD of WOMAC scores was 1.66 [95%CI （-4.03, 7.35）, P=0.57]. There were no significant differences in the ROM, HSS, KSS, and WOMAC after operation between two groups. Conclusion High-flexion implant design dose not improve overall ROM as compared to traditional implants and offers no clinical advantage over conventional implant designs in primary total knee arthroplasty.